Seizure trigger

Concept ID	Description
401019004	Trigger factor for seizure
182838006	Change of medication
1269470004	Individual dose of drug or medicament not taken
129834002	Noncompliance with medication regimen
424540004	Does not follow recommended medication dosage
6131000124104	Medication taken at higher dose than recommended
6121000124102	Medication taken at lower dose than recommended
448176008	Uses less medication than prescribed
275928001	Drugs – partial non-compliance
275927006	Drugs – total non-compliance
454161000124103	Noncompliance with medication regimen due to cognitive impairment
454211000124107	Noncompliance with medication regimen due to visual impairment
454631000124104	Refuses to discontinue medication
301345002	Difficulty sleeping
224960004	Tired
60119000	Exhaustion
130989002	Sleep deprivation
219006	Current drinker
424848002	Recreational drug user
73595000	Stress
48694002	Anxiety
386661006	Fever
39104002	Illness
422400008	Vomiting
230444006	Menstrual epilepsy
83765003	Boredom
55350005	Hungry
34095006	Dehydration
724694006	Harmful pattern of use of caffeine
1263514008	Seizure due to migraine with aura

CHAT theory also explicitly addresses five areas which if addressed systematically will help overcome stakeholder differences in pursuit of the common goal:

1. Understanding the artefacts that characterise the group and its activity.
• The artefacts might be clinical settings or the forms and templates used to capture and share information. During the pilot we heard about hard copy Dialog response forms; locally generated templates for collating information from different systems; letters and emails to GPs; images, poems or other non-text artefacts that service users might want to include in their ‘about me’ or care plan.

2. Understanding the multi-views of the group. Such groups are always a community of multiple points of view, traditions and interests.
• Different participants in the group will have different roles and will bring to the group and their roles their own histories, language, and ‘rules’. During our Stocktake preparations and workshops we worked with psychiatrists, mental health nurses, occupational therapists, social workers, transformation leads and voluntary sector representatives, all professions and interests with their own language, approaches professional ‘rules’ but united in their interest in care plans, care planning.

3. Activity systems (like the ICSs) take shape and get transformed over periods of time. ‘Historicity’ is a term coined to express how the group’s problems and potentials can only be understood against their own history.

• ‘We’ve always done it this way’, ‘that didn’t work before’, ‘it’s always like this’, ‘it wasn’t always like this’, ‘they are changing things again’, are all typical statements that often frustrate those charged with overseeing change initiatives. Without addressing the experiences that lie behind such comments you risk repeating mistakes of the past, alienating your stakeholders or just not understanding the real starting point for your transformation project. This is particularly the case for the implementation of the PCSP standard, the success of which will be largely reliant on point-of-care practices and information protocols as well as having systems which are user friendly and appropriately configured.

4. The central role of contradictions as sources of change and development. Contradictions are not the same as problems or conflicts. Contradictions are historically accumulating structural tensions within and between activity systems. Collectively addressing contradictions in how policy, practice, culture and technology interact will empower teams to find genuinely novel solutions for apparently intractable challenges, like interoperability and shared care plan/planning.

This links to the fifth principle that:

5. the possibility of expansive transformations in activity systems. As the contradictions of an activity system are aggravated, some individual participants begin to question and deviate from its established norms. In some cases, this escalates into collaborative envisioning and a deliberate collective change effort. “An expansive transformation is accomplished when the object and motive of the activity are re-conceptualised to embrace a radically wider horizon of possibilities than in the previous mode of the activity.”